Tomasz Timek1, Charles Willekes2, Olivia Hulme3, Ben Himelhoch3, Daniel Nadeau4, Andrew Borgman5, Jeff Clousing2, Dick Kanten2, Joe Wagner2. 1. Division of Cardiothoracic Surgery, Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, Michigan. Electronic address: tomasz.timek@specctrumhealth.org. 2. Division of Cardiothoracic Surgery, Meijer Heart and Vascular Institute at Spectrum Health, Grand Rapids, Michigan. 3. Michigan State University College of Human Medicine, Grand Rapids, Michigan. 4. Anesthesia Practice Consultants, Grand Rapids, Michigan. 5. DeVos Cardiovascular Research Program, and Van Andel Institute/Spectrum Health, Grand Rapids, Michigan.
Abstract
BACKGROUND: Del Nido cardioplegia (DC) offers prolonged cardiac protection with single-dose administration and has had a long safety record in pediatric cardiac surgery. However, its application in the adult population has thus far been limited. We evaluated the efficacy of cardiac protection and clinical outcomes of DC vs blood cardioplegia (BC) in adult coronary artery bypass graft (CABG) patients. METHODS: Clinical outcomes of 100 consecutive isolated CABG patients who received DC (May to September 2014) were compared with the previous 100 consecutive isolated CABG patients receiving BC (December 2013 to April 2014). Propensity matching yielded 82 pairs. The same surgeons operated on all patients. Clinical patient characteristics and data were extracted from our local The Society of Thoracic Surgeons database and the electronic medical record. RESULTS: Preoperative characteristics were similar between BC and DC patients before and after propensity matching. BC patients received anterograde and retrograde cardioplegia, whereas DC was delivered anterograde, with 92 of 100 patients receiving a single dose only. Inotropic support upon arrival to the recovery unit did not differ between BC and DC (0.28 ± 0.11 vs 0.27 ± 0.11 μg/kg/min milrinone [p = 0.8] and 0.05 ± 0.03 vs 0.05 ± 0.03 μg/kg/min norepinephrine [p = 0.7]), nor did postoperative troponin T levels (0.56 ± 0.48 vs 0.70 ± 1.27 ng/mL; p = 0.3). The peak intraoperative glucose level was higher in BC (209.8 ± 40.4 mg/dL) than in DC (161.4 ± 42.3 mg/dL) patients (p < 0.001). No patients died in either group, and the postoperative incidence of atrial fibrillation, stroke, reoperation for bleeding, and prolonged intubation did not differ between the groups before and after matching. There was also no difference in the postoperative ejection fraction between the groups (0.51 ± 0.13 vs 0.47 ± 0.13 for BC and DC, respectively; p = 0.17). CONCLUSIONS: In our initial experience, DC provided equivalent myocardial protection and clinical outcomes to BC in adult isolated CABG patients. DC was associated with lower cardiopulmonary bypass glucose levels than BC and demonstrated the feasibility of single-dose administration for routine coronary operations.
BACKGROUND:Del Nido cardioplegia (DC) offers prolonged cardiac protection with single-dose administration and has had a long safety record in pediatric cardiac surgery. However, its application in the adult population has thus far been limited. We evaluated the efficacy of cardiac protection and clinical outcomes of DC vs blood cardioplegia (BC) in adult coronary artery bypass graft (CABG) patients. METHODS: Clinical outcomes of 100 consecutive isolated CABG patients who received DC (May to September 2014) were compared with the previous 100 consecutive isolated CABG patients receiving BC (December 2013 to April 2014). Propensity matching yielded 82 pairs. The same surgeons operated on all patients. Clinical patient characteristics and data were extracted from our local The Society of Thoracic Surgeons database and the electronic medical record. RESULTS: Preoperative characteristics were similar between BC and DCpatients before and after propensity matching. BCpatients received anterograde and retrograde cardioplegia, whereas DC was delivered anterograde, with 92 of 100 patients receiving a single dose only. Inotropic support upon arrival to the recovery unit did not differ between BC and DC (0.28 ± 0.11 vs 0.27 ± 0.11 μg/kg/min milrinone [p = 0.8] and 0.05 ± 0.03 vs 0.05 ± 0.03 μg/kg/min norepinephrine [p = 0.7]), nor did postoperative troponin T levels (0.56 ± 0.48 vs 0.70 ± 1.27 ng/mL; p = 0.3). The peak intraoperative glucose level was higher in BC (209.8 ± 40.4 mg/dL) than in DC (161.4 ± 42.3 mg/dL) patients (p < 0.001). No patients died in either group, and the postoperative incidence of atrial fibrillation, stroke, reoperation for bleeding, and prolonged intubation did not differ between the groups before and after matching. There was also no difference in the postoperative ejection fraction between the groups (0.51 ± 0.13 vs 0.47 ± 0.13 for BC and DC, respectively; p = 0.17). CONCLUSIONS: In our initial experience, DC provided equivalent myocardial protection and clinical outcomes to BC in adult isolated CABG patients. DC was associated with lower cardiopulmonary bypass glucose levels than BC and demonstrated the feasibility of single-dose administration for routine coronary operations.
Authors: Michael Rosenbloom; Michael Hancock; Perry Weinstock; Allyson Paterek; Richard Highbloom; Frank Bowen; Kinjal Patel Journal: J Extra Corpor Technol Date: 2018-09
Authors: Niv Ad; Sari D Holmes; Paul S Massimiano; Anthony J Rongione; Lisa M Fornaresio; David Fitzgerald Journal: J Thorac Cardiovasc Surg Date: 2017-11-13 Impact factor: 5.209